Project 4: Economic Well being and Productivity The goal of this study is to measure the impact of ill health and functional limitations on economic circumstances and wellbeing within communities in Navrongo, Ghana; Agincourt, South Africa; and Ifakara, Tanzania. We plan baseline surveys in each country with a three year follow-up in Agincourt in year five. Undertaking the study in these INDEPTH Demographic and Health Surveillance Sites (DHSS) will allow us to combine our data with a substantial history of demographic, economic, and health measures for study participants. Ongoing surveillance will provide mortality and cause of death information. Out migrants will be followed and interviewed; pilot studies on this have proved successful in the three sites. The objective of this project is to introduce measures of household income and expenditure and work into a longitudinal survey of health and wellbeing in three INDEPTH cohorts, and to then use these measures to identify the effect of health and functioning on economic outcomes and wellbeing among the elderly. This project is closely linked to the other projects in this proposal. The measures of income and economic well-being generated in this project will be used as factors that affect physical and cognitive functioning (Project 1), cardiometabolic disorders (Project 2), and HIV incidence and treatment (Project 3). The effect of HIV/AIDS on wellbeing raises special issues and is examined in Project 3. The specific aims of this project are: 1. To measure and describe the relationship between aging, health, economic outcomes and wellbeing of older people across three communities in Sub-Saharan Africa. 2. To study the causal effect of health on work, income, and wellbeing in the three populations. The measurement aim will be innovative in providing linked health and economic data on older people in Sub-Saharan Africa, this also innovative in developing a methodology for creating income measures from household asset ownership in a way that will allow us link existing asset data from the three sites to the comprehensive income and expenditure we will have. In aim 2 we will innovate by using novel methods to identify health to income effects. These include using participation in past studies and interventions in the sites (testing and referral for hypertension, and a family planning intervention) to identify casual mechanisms.